Health Maintenance Organization Amendments

Health Maintenance Organization Amendments - Title I: Amendments to the Public Health Service Act - Extends the authorization of appropriations under the Public Health Service Act through fiscal year 1981 for: (1) grants and contracts for surveys of the feasibility of establishing, operating or expanding health maintenance organizations (HMO's); and (2) grants, contracts, loans and loan guarantees for planning and initial development costs related to the establishment of HMO's.

Prohibits a health maintenance organization from paying more than 15 percent of the estimated total amount to be paid for basic and supplemental health services in a given fiscal year to individual physicians under contract to the HMO. Implements such prohibition over a four-year period.

Requires HMO's to provide the Secretary of Health, Education, and Welfare with specified information on major financial transactions among HMO's and related organizations.

Repeals the requirement that the Secretary give priority to an application for funds for a feasibility survey or planning and initial development costs for an HMO in which 30 percent of the members are members of a medically underserved population.

Increases the maximum amount available for grants for the initial development and operation of HMO's.

Authorizes the Secretary to make loans to public or private entities for the acquisition, construction, renovation, or purchase of ambulatory care facilities for HMO's.

Repeals the prohibition against using funds appropriated under the Public Health Service Act, other than under the title pertaining to HMO's, for projects involving HMO's.

Requires health systems agencies in reviewing facilities, equipment, or services of HMO's to include only those standards specified by the Secretary.

Title II: Amendments to Titles XI and XVIII of the Social Security Act - Amends Title XI (General Provisions and Professional Standards Review) of the Social Security Act to remove HMO's from the capital expenditures limitations of the Medicare, Medicaid, and Maternal and Child Health programs of such Act.

Permits a HMO, under Title XVIII (Medicare) of such Act, to have more than 50 percent of its membership over the age of 65 if the HMO is a public HMO, receives funding under the Community Health Centers program of the Public Health Service Act, or is granted a waiver by the Secretary.

Requires the Secretary, to annually determine a per capita rate of payment to each HMO for services provided under the Medicare program. States that such payment shall be equal to 95 percent of the adjusted average per capita cost. Requires the Secretary to pay each HMO its rate on a monthly basis in advance.

Title III: Amendments to Title XIX of the Social Security Act - Permits a HMO to have more than 50 percent of its membership as Medicare or Medicaid recipients if the HMO is a public HMO, receives funding under the Community Health Centers program, or is granted a waiver by the Secretary.

Requires a State to enter into a provider agreement under the Medicaid program with any HMO which requests such an agreement. Declares that under such agreement, the State will reimburse the HMO for services and benefits covered under the State Medicaid plan. States that such payment shall be equal to 95 percent of the adjusted average per capita cost of care to members of the HMO. Requires the State to pay each HMO its rate on a monthly basis in advance.